Doctors fear Trump change could lead to more teen pregnancies

Dr. Claire Brindis of UCSF (right), with research coordinator Shira Rutman, says the drop in teen births could be reversed.

Dr. Claire Brindis of UCSF (right), with research coordinator Shira...

High school students toting both textbooks and newborns are becoming increasingly rare. But a Trump administration proposal to rewrite federal birth control mandates could soon change that, some medical experts fear.

The teenage birth rate in the United States has hit an all-time low after nearly three decades of decreases, data from the Centers for Disease Control and Prevention show. The number of 15- to 19-year-olds who gave birth in 2016 was down 9 percent from the year before, to 20.3 births per 1,000 women. Since 1991, the rate has plummeted by 67 percent, the biggest drop since the CDC began tracking the data nearly eight decades ago.

More than half of teens have had sex by age 18, the CDC found — a rate that’s down a bit from the early 1990s, but not nearly as sharply as the number of births. Medical professionals and policy experts say increased contraception use has contributed to the decline in teenage motherhood.

Teenage birth rates have “been going in this direction for a while,” said Elise Berlan, an adolescent-medicine physician at Nationwide Children’s Hospital in Columbus, Ohio, and lead physician of the Young Women’s Contraceptive Service Program, which offers birth control to teenagers.

“Birth control is really driving these numbers,” Berlan said. “Access to health insurance is really the important thing to note. Threats to coverage for children and adolescents do have the potential to impact access to contraceptives and things like the birth rate.”

That rate could be affected by President Trump’s executive order in May to draft a religious exemption to the government’s contraception coverage mandate, experts say.

The Affordable Care Act requires that birth control be included under any health care plan. An interim rule drafted by the Health and Human Services Department and political appointees at the White House would allow employers to deny contraception coverage on religious grounds to women who now receive birth control through their health care plans.

Trump issued his executive order in response to protests from religious universities and Roman Catholic organizations including the Little Sisters of the Poor, which took a legal challenge to the birth-control mandate all the way to the U.S. Supreme Court. The justices sent the case back to lower courts in May without ruling on its merits.

The policy change explains that the rules will “result in some enrollees ... not receiving coverage.” The draft rule is still under review by the administration but could take effect immediately after being published in the Federal Register. Public comment often follows an interim final rule, however, and the new regulation can be revised.

“I will make absolutely certain religious orders like the Little Sisters of Poor are not bullied by the federal government because of their religious beliefs,” Trump wrote in October in a letter to leaders of Catholic organizations.

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The Trump administration’s proposal to rewrite birth control rules could curb teens’ access to contraceptives.

The Trump administration’s proposal to rewrite birth control rules could curb teens’ access to contraceptives.

Photo: Nicole Boliaux, The Chronicle

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Dr. Claire Brindis, who heads UCSF’s Institute for Health Policy Studies and is an expert on sex education and reproductive health research, says that of teens “who are sexually active, they are using contraceptives more frequently and using more effective methods. If you take that away, it could reverse this trend.” less

Dr. Claire Brindis, who heads UCSF’s Institute for Health Policy Studies and is an expert on sex education and reproductive health research, says that of teens “who are sexually active, they are using ... more

Photo: Nicole Boliaux, The Chronicle

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A figurine of Wonder Woman sits on the shelf in Dr. Claire Brindis’ office at UCSF Laurel Heights campus in San Francisco.

A figurine of Wonder Woman sits on the shelf in Dr. Claire Brindis’ office at UCSF Laurel Heights campus in San Francisco.

Photo: Nicole Boliaux, The Chronicle

Doctors fear Trump change could lead to more teen pregnancies

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The Becket Fund for Religious Liberty, a nonprofit law firm that represented the Little Sisters, said it was “sensible and fair” not to force nuns to provide birth control.

In 2016, 55 million women received birth control with no co-pay through their health insurance, according to an Obama administration study. There are no data indicating how many of those women were teenagers. It is also unknown how many groups could claim religious exemptions under the proposed Trump rule, cutting off access to contraceptives through a health care plan.

But any reduction in the number of teenagers who can get their birth control through health plans jeopardizes gains the U.S. has made in driving down the birth rate among young people, medical professionals say. They noted that the U.S. rate is still higher than in other developed countries such as Canada, Germany and France.

“We don’t have a reduction in the number of young people having sex,” said Claire Brindis, who heads UCSF’s Institute for Health Policy Studies and is an expert on sex education and reproductive health research. “But of the ones who are sexually active, they are using contraceptives more frequently and using more effective methods. If you take that away, it could reverse this trend.”

Besides, Brindis added, teenagers have other goals in mind. Most don’t want to get pregnant.

That’s certainly the case for Tierra White. There are things the 15-year-old Mission District resident wants to achieve in the next few years, like graduating from high school and studying nursing at Columbia University in New York. Becoming a mother isn’t on the list.

“Having a baby doesn’t fit into that, because you have to be able to take care of a baby and buy stuff for it,” Tierra said. “It takes a lot of time to raise a baby. It’s better to wait until you’re older and finish school and get a good education.”

In San Francisco, the birth rate for girls ages 15 to 19 has fallen even more sharply than it has nationally. There were 124 babies born to teenage mothers in the city in 2015, compared with 264 in 2009.

Officials with the city Department of Public Health say the reasons for the local decline aren’t completely understood, but that delaying sex and increasing long-term birth control, like intrauterine contraceptive devices, also known as IUDs, and Depo-Provera birth control shots, are contributing factors.

State and local programs could provide a backstop for some teenagers if their birth-control benefits are cut off as a result of Trump’s executive order. Covered California, the statewide health insurance marketplace, requires insurance plans sold to individuals to pay for at least one type of birth control.

Low-income people can get free birth control through programs funded by Title X — federal grant money that goes to family planning services. Last year, 1.2 million people in California received care through such funding.

San Francisco also runs a network of youth clinics, and the San Francisco Unified School District features the Be Real, Be Ready sex education program, which notes effective and emergency birth control.

Nearly 30 percent of high school freshmen have had sex, studies show, and the number rises by 10 percentage points with each following year. Dr. Sophia Yen, a clinical associate professor of pediatrics and adolescent medicine at Stanford University, said teaching young people about safe sex is key.

“California has always been a leader,” Yen said. “Our state has shown the highest declines in teenage births consistently. Research has shown over and over again that teens have sex. We just want to make sure they have it protected. If you want to stop teen pregnancy, you need access to health care and those resources.”